Insurance Reform Opportunities, Challenges Evident in Camden

City residents could benefit greatly from federal healthcare law, but obstacles are daunting

Dr. Jeffrey Brenner, at right, director of the Urban Health Institute of Cooper University Health Care and executive director of the Camden Coalition of Healthcare Providers, says the ACA offers great challenges and great opportunities.

It’s going to be a challenge to provide health insurance to more than 900,000 uninsured New Jersey residents -- and that challenge will be even greater in Camden, where the percentage of people without insurance is more than twice the state average.

But this challenge also offers a great opportunity, says Dr. Jeffrey Brenner, director of the Urban Health Institute of Cooper University Health Care and executive director of the Camden Coalition of Healthcare Providers.

“It’s going to be a lot of work by everybody in this room and all across the city” to enroll people in one of the the Affordable Care Act insurance plans, Brenner said. “It would be a tragedy for Barack Obama to fight for the passage of the Affordable Care Act and we not do the job locally to make sure that every Camden resident that is eligible gets signed up.”

Brenner spoke during a forum held Monday for healthcare professionals who will be treating the additional patients newly insured under the ACA.

Camden has an estimated 7,300 uninsured residents who are now eligible for New Jersey Family Care, the state’s Medicaid program, and 10,000 uninsured residents eligible for subsidies to buy insurance through the new federal marketplace, or exchange, according to Brenner, a recent MacArthur Foundation fellow who is a national leader in efforts to coordinate care for chronically ill patients.

Brenner said many of the uninsured Camden residents are single men who weren’t previously eligible for Family Care.

“Moms and kids are more politically popular than single men who are 40 and homeless,” Brenner commented.

He said the group includes a significant number of former inmates who received healthcare in prison but lost their government-paid healthcare after being released.

Brenner said it’s going to be impossible to enroll everyone eligible for insurance during the six-month open enrollment period that ends on March 31, 2014. He noted that it took two to three years for Massachusetts, with its similar program which preceded the ACA, to enroll nearly everyone who was eligible.

As the ACA heads into the future, Brenner predicted, the focus will shift from expanding access to improving the quality of care while lowering costs. He said Massachusetts made that shift once it finished expanding the number of people with coverage.

He pointed out that area hospitals have a major opportunity to help every eligible uninsured patient who comes through their doors to enroll for insurance coverage. He said that half of the city’s population visits an emergency room over the course of a year, and many of them are uninsured.

Brenner predicted that some hospitals might actually pay for some patients’ healthcare premiums in order to get them enrolled in insurance plans, so that the hospitals can then be reimbursed for services. Hospitals have been expressing interest in this option, and a recent federal regulatory ruling opens it up as an possibility.

Catherine Oakar, director of public health policy for the U.S. Department of Health and Human Services, cited statistics to illustrate how the ACA will benefit Camden residents.

She said 88 percent of New Jersey’s uninsured population is eligible for either Medicaid or ACA subsidies to buy insurance.

“We have a huge opportunity to help so many people, and these are some of the most vulnerable people in the country,” Oakar said. “Despite any type of discouragement we may feel, or the tough work that lies ahead, this is a huge opportunity.”

She added that Americans have already been paying a “hidden tax” to cover the cost of uncompensated care – through higher premiums and higher taxes. She cited an estimate that this “tax” amounts to about $1,000 per family.

Oakar added that the healthcare.gov website is functioning better, with the number of people able to enroll increasing by a multiple of four from October to November.

“If you had trouble in the past, come back” to the site, Oakar urged. Oakar also pointed out that the ACA provides benefits to those who already have insurance. For example, the law requires that all insurance plans provide annual preventive care visits free of cost. In addition, it prohibits lifetime limits on the value of benefits that insurance provides.

Speakers at the event, which was held at Rowan University’s Cooper Medical School, also discussed the changing model of delivering care and how that is affecting both Camden and the entire country.

Louis S. Bezich, Cooper’s chief of staff and executive director of population health management, described changes needed to fix flaws in the national healthcare system that have led to spiraling medical costs.

Bezich described current efforts as a “sick-care model,” with inverted economic incentives that reward providers for giving more care and treatments rather than for good health outcomes.

But he also cited estimates that improving healthcare would only forestall 10 to 15 percent of preventable deaths. The most powerful drivers of health – or lack of good health -- are lifestyle, living conditions and socioeconomic factors.

Cooper is trying to coordinate the efforts of healthcare providers while providing incentives for their patients to participate in wellness programs focused on diet and exercise, Bezich said. These new healthcare models also reward or penalize providers based on the outcomes for their patients.

Bezich said Cooper’s partial ownership of the insurer AmeriHealth New Jersey is already bearing fruit, including the launch of AmeriHealth’s Cooper Advantage Plan on the ACA marketplace; the plan offers access to a network of Cooper healthcare providers at a reduced cost.